达格列净致非高血糖性糖尿病酮症酸中毒1例报告  

Euglycemic Diabetic Ketoacidosis Induced by Dapagliflozin:a Case Report

作　　者：焦丽婷 邹芳[1] 魏美林 赖晓阳[1] JIAO Li-ting;ZOU Fang;WEI Mei-lin;LAI Xiao-yang(Department of Endocrinology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院内分泌科,南昌330006

出　　处：《南昌大学学报（医学版）》2023年第5期92-95,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的报告1例达格列净致非高血糖性糖尿病酮症酸中毒(euDKA)病例,并为临床合理用药及治疗提供参考。方法对南昌大学附属第二医院2022年7月收治的1例使用达格列净后出现euDKA的病例资料进行回顾性分析。结果患者服用达格列净约10个月时于2022年7月3日左右出现腹痛,偶有进食后恶心、呕吐不适,症状加重后于7月23日住院治疗,入院检查结果:随机血糖9.08 mmol·L^(-1),尿酮体3+,结合病史诊断为达格列净所致euDKA。立即停用达格列净,并予以大量补液、小剂量胰岛素静脉滴注、纠正电解质紊乱等对症治疗,但酮症酸中毒仍未纠正。于治疗第3天补充极化液(10%葡萄糖500 mL配以胰岛素注射液16 IU、10%氯化钾10 mL),治疗第5天尿酮体开始逐渐消退,症状好转,至第7天尿酮转阴。结论钠-葡萄糖协同转运蛋白2抑制剂(SGLT-2i)使用过程中应常规监测尿酮,用药前建议检测谷氨酸脱羧酶65(GAD65)抗体或C肽水平,排除1型糖尿病,使用后如有不明原因腹痛、恶心、呕吐等需警惕SGLT-2i相关性酮症酸中毒可能。Objective To report a case of euglycemic diabetic ketoacidosis(euDKA)induced by dapagliflozin,and to provide reference for clinical rational drug use and treatment.Methods The data of a case of dapagliflozin-induced euDKA admitted to the Second Affiliated Hospital of Nanchang University in July 2022 were analyzed retrospectively.Results About 10 months after taking dapagliflozin,the patient developed abdominal pain around July 3,2022,accompanied with occasional nausea and vomiting after food intake,and hospitalized on July 23 as the aggravation of symptoms.The admission examination indicated random blood glucose of 9.08 mmol·L^(-1) and urinary ketoacidosis of 3+.After making a detailed inquiry about medical history,the patient was diagnosed as euDKA caused by dapagliflozin.Then,dapagliflozin was stopped immediately,and symptomatic treatment such as large amount of fluid replacement,small dose of intravenous insulin infusion and correction of electrolyte disorder was performed in this patient.However,the ketoacidosis was still not corrected.On the 3rd day of treatment,hypertonic glucose(1000 mL 10%glucose combined with 16 IU insulin and 10 mL 10%potassium chloride)was supplemented.The ketonuria began to gradually subside with symptoms improvement on the 5th day,and turned negative on the 7th day.Conclusion Urine ketone levels should be regularly monitored during the use of sodium-glucose co-transporter-2 inhibitors(SGLT-2i),and anti-glutamic acid decarboxylase 65 antibody or C-peptide levels should be detected to exclude type 1 diabetes before the use of SGLT-2i.If there is unexplained abdominal pain,nausea and vomiting after SGLT-2i use,the possibility of euDKA should be on the alert.

关 键 词：非高糖性糖尿病酮症酸中毒 钠-葡萄糖协同转运蛋白2抑制剂 达格列净 病例报告 

分 类 号：R587.2[医药卫生—内分泌]